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Expanding the Toolbox for Suicide Prevention
Suicide prevention remains one of the most critical challenges in mental health care. Traditional suicide risk assessment frameworks often prioritize classification and risk documentation, potentially at the expense of fostering meaningful therapeutic relationships. In her CE/CME presentation, “Transforming Suicide Risk Assessment,”Dr. Katie Lewis, Director of Research at the Austen Riggs Center, outlines a transformative approach that emphasizes empathy, collaborative engagement, and the integration of dynamic, context-sensitive assessment strategies.
Lewis notes suicide is a current research focus and common clinical concern for Austen Riggs Center patients with nearly half having made a suicide attempt prior to being admitted and 80% reporting recent suicidal ideation. Lewis's approach combines evidence-based tools with innovative practices to more effectively understand and address the complexities of suicide risk.
Reconsidering the Nature of Suicide Risk
Suicide risk is dynamic, influenced by fluctuating situational and emotional factors that complicate its prediction. Lewis highlights the limitations of relying solely on static risk factors, such as prior attempts, and underscores the importance of addressing psychological pain and lived experiences that contribute to suicidal ideation.
Her research with colleagues indicates that suicide risk is highly context-dependent. For example, during the COVID-19 pandemic, reduced social contact was strongly associated with increased suicidal ideation, while greater social connection corresponded with lower risk. These findings reinforce the importance of considering short-term, situational triggers alongside broader risk factors to develop a more nuanced understanding of suicide risk.
Limitations of Current Assessment Tools
Widely used tools like the Columbia Suicide Severity Rating Scale (C-SSRS) provide essential structures for suicide risk assessment but often fail to address the relational aspects of care. Patients frequently report feeling objectified or dehumanized during these assessments, as the focus on compliance and documentation can overshadow meaningful interaction.
Lewis notes that the emphasis on liability management or clinician anxiety during these evaluations may detract from the therapeutic relationship. This disconnect can limit the utility of these tools and potentially reduce their efficacy in suicide prevention.
A Relational Approach to Suicide Risk Assessment
Lewis advocates for reimagining suicide risk assessment as a collaborative and relational process rather than a checklist-driven task. Key components of her approach include:
- Exploring Psychological Pain: Recognizing that suicidal ideation often arises from profound psychological pain, clinicians should create space for open and empathetic conversations about patients' emotional distress. Learn more about psychological pain in suicide.
- Identifying Contextual Triggers: Beyond static risk factors, Dr. Lewis recommends focusing on individualized patterns and situational triggers to better understand fluctuations in suicide risk. Explore If . . . Then behavioral contingencies.
- Fostering Collaborative Relationships: Risk assessments should aim to strengthen the therapeutic alliance, empowering patients to participate actively in their care and fostering a sense of trust and safety. Learn about the Collaborative Assessment and Management of Suicidality (CAMS).
This approach aligns with a broader shift toward person-centered care, integrating the patient’s unique experiences and perspectives into the assessment process.
Emerging Practices in Suicide Prevention
Several novel interventions align with Lewis’s relational framework, offering mental health professionals additional tools to enhance their practice:
- Attempted Suicide Short Intervention Program (ASSIP): ASSIP focuses on exploring psychological pain and constructing a coherent narrative to understand the origins of suicidal impulses. It aims to build curiosity and insight while mitigating risk.
- Collaborative Assessment and Management of Suicidality (CAMS): CAMS emphasizes a partnership model, focusing on identifying psychological pain and protective factors while collaboratively developing safety plans.
- Real-Time Monitoring Techniques: Methods like ecological momentary assessment (EMA) provide actionable data by capturing real-time fluctuations in suicidal thoughts and contextual triggers, facilitating timely and targeted interventions.
- Therapeutic Questionnaires: Instruments such as the Psychic Pain Scale enable deeper exploration of emotional distress and help clinicians tailor interventions to individual needs.
A Paradigm Shift in Suicide Risk Assessment
Lewis envisions suicide risk assessment as an opportunity to foster trust and build therapeutic alliances rather than a purely diagnostic exercise. By prioritizing connection and relational engagement, clinicians can help patients regain faith in relationships as sources of safety and protection. This approach redefines the assessment process as an avenue for restoration, not merely risk stratification.
Mental health professionals are uniquely positioned to make every clinical interaction with a suicidal patient an opportunity for meaningful connection. By embracing this relational model, clinicians can create a stronger foundation for intervention, support, and hope.
For more insights from Lewis’s presentation, the thoughtful Q&A that followed, and to earn CE/CME credits, visit the Austen Riggs Center’s continuing education course page. This transformative approach invites clinicians to rethink how they assess and engage with suicide risk, fostering deeper connections and more effective care.